Definition:
Transplantation is the process of taking a graft – i.e. cells,
tissues, organs from one person (who is the donor) and placing it
into another person (the recipient). If the graft is placed in
it’s normal location, then it is orthotopic
Transplantation. Examples are heart, liver, lung transplant. If
the graft is placed at another site it is calledheterotopic
Transplantation as in kidney and pancreatic transplants.

Syngeneic
Transplant:
This is a transplant between 2 genetically identical individuals
as in identical twins. Since the donor and recipient are
genetically identical there is no graft rejection.

Allogeneic
Transplant:
This is a transplant between 2 genetically different members of
the same species. eg. Transplant between rat and rat, dog and dog
man and man,.

Xeno
Transplant:
This is a transplant between members of difference species. For
example between pig and man, baboon and man.

Auto
Transplant:
This is a transplant from one site to another in the same
individual. eg. Skin graft, bone graft.

A
transplant from a non-living donor is called a cadaveric
transplant.

A
transplant from a living donor can be of two types: a transplant
from a blood relative is called ‘living related’ transplant. A
transplant from non-related persons is called ‘living
non-related’ transplant.

Ethical
Considerations in Cadaver Organ Transplantation

1.With
the passage in the Indian Parliament of “The Transplantation of
Human Organs Act 1994”Cadaver
Organ Transplantation has legal sanction in India.

2.
Before embarking on transplantation of organs harvested from brain
dead donors we should examine the ethics of this form of
transplantation. Is it in keeping with our ancient religious
philosophies?

3.
Abortion or the euphemistically termed “Medical termination of
pregnancy – MTP” is a good example of the dichotomy between
what is legal and what is ethical. While the state sees MTP as a
pragmatic solution to an exploding population many doctors refuse
to carry out abortions.

The
first question relates to brain death.
There are two means by which death may be determined: 1) the total
cessation of circulatory and pulmonary functions or 2) the total
cessation of all brain functions including the brain stem. For the
lay person the brain death concept may be clouded by suspicion. He
or she would question whether a patient whose heart is beating but
whose brain shows no activity is indeed dead.

Today
medical evidence is clear that all brain dead persons are dead.
In a brain dead individual the heart would stop without support.
Even if the heart were supported for an indefinite period of time,
the brain would never recover even its most primitive functions.
This change of concept may be difficult for us to accept because
we have been used to the idea that the most reliable indicator of
death is a heart, which stopped and is incapable of being revived.

The
second issue is whether this
change of concept of death, will open the flood gates of abuse.
In other words, would it be likely that in our anxiety to sustain
a transplant programme, we would declare death when all criteria
for brain death are not unequivocally present. This will not
happen for two reasons. First, the law has intrinsic safeguards,
which are more stringent than those in the UK and the USA. Second,
the environment in our hospital will serve as a check to abuse.

The
next concern is the donor family. Will
relatives of the brain dead patient be pressurised into agreeing
to organ donations? It is necessary thatwe set up a mechanism to ensure that relatives are kept
informed of the patient’s progress and their rights. We must
ensure that the next of kin makes an informed decision in an
unpressurised setting. The bereaved family must have every
opportunity to opt out of donation. We should also make certain
that the relativesof
potential recipients do not approach the potential donor relatives
with offers of money or other forms of inducement. Strict
confidentiality should be maintained about the identities of the
donor and the recipients. The donor relatives should not know the
identity of the donor and the recipients. The donor relatives
should not know the identity of the recipients who have benefited
from the harvested organs. Likewise the recipients should be
unaware of donor identity. One person from the transplant team
should be designated to explain and seek permission for organ
donation from the potential donor relatives once brain death has
been declared. The bereaved family needs to understand that
“Brain death is death of the person” and that organ
donation is the gift of life to another person. Studies from
countries where cadaver organ transplantation is being performed,
show that the donor families consider the act of organ donation as
the highest form of charity, and it has given them solace and
lessened the pain of their loss.